The Trauma of Forced Treatment for People with Eating Disorders

Forced treatment has been a component of eating disorder treatment since its inception. The concept of a treatment intervention began in substance abuse treatment and transferred primarily to severe cases of Anorexia Nervosa.

The theory behind an intervention is that a central facet of the illness is denial. The person has little if any insight into the problem, minimal desire for change, if any, and significant risk of medical symptoms or even fatality.

Forced hospitalization feels like the only option for families in this situation as they fear for the safety, health and even life of their loved one. With encouragement from professionals, families, often reluctantly, agree to take this drastic step.

The intervention undoubtedly leads to short-term relief. The person is temporarily safe. Their medical and psychiatric conditions improve from nutrition, and the family hopes that the intervention predicts healing and recovery.

However, people with anorexia forced to eat will comply in the short-term, but that nutrition will not change the core beliefs of the disorder about food restriction and weight loss. Rarely, an early intervention can reverse the course of the illness, but much more often this step hardens the eating disorder thoughts and behaviors as a reaction to being trapped to do the action most abhorrent and terrifying to them. Even though families may even not feel like there is a better solution in the moment, interventions are far from a panacea.

One major risk of forced treatment is the traumatic effect on the patient. They will feel as if they are being forced to do the one thing that every part of their being is fighting. The thoughts are so strong to restrict and each bite, each snack, each meal can cause extremely painful emotional responses. For others who don’t have anorexia, the pain caused by forced eating is hard to imagine.

As the person endures the food and weight gain that follows, many feel traumatized by the experience. They feel they are forced to do something extraordinarily painful day after day for months with minimal understanding or compassion. They feel abandoned and betrayed by their loved ones and locked up in a tortured environment for months on end.

The younger the patients, often the more traumatic the responses.

The result is not only hardened eating disorder symptoms but trauma symptoms such as constant reminders of the treatment, nightmares and fear of the people they love most.

Seeing patients years out from their experience still having trauma symptoms certainly makes one question the benefit of forced treatment.

The trauma caused by forced treatment is one the eating disorder treatment community needs to grapple with and needs to stop.

When forced treatment is needed to save someone’s life, then thoughtful steps to mitigate the potential trauma need to be considered. If that means shorter term care to stabilize someone medically rather than months of treatment, that may be a more humane and compassionate step to consider. Any intervention must take into account the risks from the start.

The Causes of Trauma Caused by Residential Treatment

At an eating disorder clinician holiday party last week, an outreach representative from a venture-owned eating disorder treatment program approached me. As she discussed the changes in her program, she focused on how beautiful the new outpatient facility is, as if a new renovation were the best selling point for comprehensive eating disorder care.

The obvious takeaway is that the monetization of eating disorder treatment has supplanted the need for effective and compassionate treatment.

But my mind drifted instead to an ignored topic in eating disorder care: trauma caused by residential programs and hospital programs.

To be clear, many people receive substantive, effective care at these programs, even the ones backed by financial companies.

Many people, especially young people and adolescents, also have traumatic experiences at treatment programs which cement the power of the eating disorder and layer an unnecessary and entrenched mental health issue which makes recovery much harder. A traumatic treatment experience often leads people to stop seeking care completely. Destroying trust in the treatment process forces patients down a path of a chronic eating disorder and little chance for recovery or even relief.

Sometimes a treatment program won’t be helpful and that’s ok. But no treatment should be traumatic and worsen a patient’s illness. That’s unacceptable.

The next few posts will focus on various ways residential and hospital-based programs are traumatic. I’ll also focus on ideas to limit this horrible and avoidable damage.

The posts will discuss the following ideas: forced treatment stays, treating patients like children, relentless focus on weight in recovery, ensuring programs have adequately trained supervisors and creating a standard for adequate education and experience.

The Place of Eating Disorders in the History of Psychiatric Illnesses

Psychological maladies have shifted due to cultural changes in the history of the last two centuries. The psychological and emotional struggles are consistent, but the physical symptoms associated with that stress change due to new societal norms and expectations.

There have been various symptoms over these years as a result of stress and anxiety: fainting spells, prolonged periods of weakness, “hysteria,” mental breakdowns, self-harm and now eating disorders.

The sharp rise in the incidence of eating disorders in the most recent decades reflects the transition of psychological symptoms in the climate of diet culture. The extreme focus on thinness encouraged young people to diet in order to manage their emotional struggles, and dieting is the number one risk factor for developing an eating disorder.

Like all of the manifestations of emotional issues, addressing the physical issue will uncover the psychological ones. However, eating disorders are different.

For the other issues, working on the emotional piece can eliminate the physical symptom almost immediately. For eating disorders, the fundamental change in eating disorder behaviors doesn’t change so easily.

The disordered way of eating is often ingrained quickly for people with eating disorders as a way of coping through the numbing effect of the symptoms and the powerful, unconscious eating routines that can be comforting.

Once the mind and body adjust to a new way of eating, even a disordered one, it takes an enormous amount of work to make a new eating pattern stick. As the person finds new ways to cope emotionally with the struggle that led them to the eating disorder itself, they also need to relearn how to eat. The process of figuring out how to eat can take a long time and a lot of effort.

The epidemic of eating disorders stems from the transition of emotional struggles to the newest cultural phenomenon: diet culture. As it turns out, reversing eating disorder symptoms take a lot more time and effort than reversing other physical manifestation of other psychological problems in past generations.